Author: admin | 10.10.2015

Roseola rash is a common viral disease that affects kids, particularly those between 6 months to 2 years old. Studies show that roseola have higher risks in older infants because they have yet to develop antibodies against certain virus; whereas, while they are still in the mother’s womb, they are well protected by the mother’s immune system. After exposure of the child to someone who has roseola rash, it would take for approximately one to weeks for the symptoms to appear.
The kind of fever that hits the child is usually sudden and a high one, which is often 103°F or 39.4°C.
After a few days the fever had set in, rashes typically appear, but may not happen to some other patients. Although a roseola rash is not a serious condition, but the high fever that it may bring is something that one should be wary about. The culprit of this disease is the human herpes virus 6 (HHV6), but studies show another causative agent, which is the human herpes virus 7 (HHV7). As part of proper management of the condition, an appointment with the physician is always sought especially if the rashes do not improve or disappear after a few more days and a high fever that lasts for more than a week.
Roseola rash is considered to be a mild viral disease; therefore treatment is not usually indicated. Antiviral medications can also be given to children as there is no specific treatment for this disease.
Fluid Intake – Increasing the fluid intake (water, juices, lime soda, electrolyte solution) will facilitate release of impurities out from the body through frequent urination. Healthy diet – Always maintain a healthy diet to make sure that children will have a complete supply of nutrients their body needs for optimum protection from certain organisms that would bring harm to them.
Sponge baths – Lukewarm sponge bath or cool washcloth can be used to lower the fever and discomfort.
Although it is very rare, if in any case treatment of roseola may not be successful, there can be serious complications that go with it. The serious thing about roseola is that it is contagious, even if the affected individual has not been clearly diagnosed yet. Therefore the best way to prevent the spread of the virus is to observe proper hand washing. The other name for the Butterfly Rash is malar rash and it mainly appears at the cheek bone area.
The differential diagnosis of acute fever and rash in an adult is quite extensive and includes a variety of infectious and non-infectious causes.
This chapter emphasizes the approach to the patient with fever and rash and will cover the common etiologies for this presentation in the adult patient.
There are a limited number of skin manifestations that can result from a variety of insults including infection. A variety of mechanisms may be involved in the pathogenesis of skin manifestations associated with infection.
A thorough history is extremely important in limiting the differential diagnosis for the adult with fever and rash (Table 1). The history should also include specifics about the rash: where and when were the lesions first noticed, the nature of the lesions, the timing of the development of the skin findings with any associated symptoms, the pattern of spread or any change in the morphology of the lesions over the course of the illness, and if the lesions are painful or pruritic.
The differential for fever and rash in an adult is divided into categories based on the character of the predominant skin lesion. When examining the patient with fever and rash it is important to examine the entire skin surface in good light, preferably natural light. Patients with asplenia are at increased risk for overwhelming infection withA Neisseria meningitidis, but even in normal hosts infection with this organism can present as fever and petechial rash. A similar clinical picture can be seen in patients with Rocky Mountain spotted fever (RMSF), which is caused byA Rickettsia rickettsii. Patients with functional or anatomic asplenia are at increased risk for sepsis with encapsulated bacteria and are predisposed to the development of coagulopathy and purpuric lesions duringA bacteremia.
There are a variety of non-treatable infections that can present with fever and petechial rash.
The listof non-infectious entities that can present with fever and petechial rash is extremely long. It is important to distinguish cellulitis fromA necrotizing soft tissue infectionsA that can be seen with a variety of different pathogens. In Staphylococcal Scalded Skin Syndrome (SSSS) patients present with fever and a scarlatiniform eruption. Lyme disease, caused by the spirocheteA Borrelia burgdorferi, can present with flu-like symptoms and rash. Leptospirosis, psittacosis, and rate-bite fever are uncommon causes of fever and rash syndrome seen in patients with specific exposure histories.A LeptospiraA infection is acquired from direct or indirect contact with urine or tissue from infected animals. Pseudomonas aeruginosasepticemia, especially in neutropenic hosts, can present with scattered skin lesions.
As mentioned previously enteroviral infections can present with variable skin manifestations.
Lesions of erythema multiforme have central erythema surrounded by normal-appearing skin that in turn is surrounded by another ring of erythema. In several infections the primary lesion may be a papule, which forms a vesicle that leads to ulcer formation and eschar .
Anthrax, caused byA Bacillus anthracis, has received a great deal of attention because of its use as a bioterrorism agent.
Yersinia pestis, the organism that causes plague, has also received a great deal of interest as a potential bioterrorism agent.
Most of the illnesses associated with fever and nodular skin lesions are confined to patients who are immunocompromised (Table 9). Erythema nodosum is characterized by tender erythematous nodules usually confined to the lower extremities. Most of the syndromes that present with significant joint symptoms associated with fever and rash have already been mentioned in prior sections (Table 11). Hepatitis B virusA infection can present with rash (urticarial or maculopapular) and an oligo- or poly-arthritis.
Acute rheumatic fever (ARF) is a clinical syndrome that develops following aA group A streptococcalA (GAS) infection. This chapter has tried to provide a framework for the approach to a patient with fever and rash (Table 13). However, this direct protection from their mother fades away with time, and this makes them vulnerable to viral diseases such as roseola. If the child would experience a fever of 103°F and higher and may last for more than seven days already, it is recommended to have the child seen by a doctor. Once a person is infected with such virus, the virus will be transmitted to another individual by direct contact with the infected person through respiratory secretions and saliva. With doctor’s prescription, fever can be managed by over-the-counter medications such as acetaminophen or ibuprofen.
Therefore it is recommended for children to get enough rest, especially when accompanied by fever, to completely recover.
Avoid using ice, cold water, or cold baths as they may cause rapid decrease in temperature and may lead to chills.
Since some patients may not manifest the rashes that are typical of roseola and show only fever, there is a big possibility that they can already infect others who may come in contact with them. Since children are fond of touching a lot of objects that come in contact with their hands, it is always the responsibility of the caregiver or the mother to wash the child’s hands regularly or disinfect toys and materials that they use. The typical high fever will run for three to seven days followed by the appearance of the pinkish red rashes. Infectious disease emergencies and diseases that can have public health implications can present as fever and rash. There are many important causes of fever and rash in the pediatric population but this chapter will concentrate on this problem in adults. Involvement in specific activities provides the potential for exposure to specific pathogens.
Patients present with abrupt onset of high fever and severe frontalA headacheA within a week of a bite from an infected tick.
It is usually associated withA pharyngitisA but it can occur following streptococcal infections at other sites. The lower extremity is the most common site for cellulitis but infection can occur at any site where pathogenic bacteria are inoculated into the skin. The rash is localized to the trunk and the proximal upper extremities and does eventually desquamate with time. The differential diagnosis for fever and a maculopapular eruption is extensive and includes many non-infectious entities. Children present with a classic slapped-cheek appearance followed by a more generalized maculopapular rash. The most common features of the Acute Retroviral Syndrome (ARS) areA fever, pharyngitis, lymphadenopathy andA rash. This is generally a mild disease in infants and children but it can cause a mononucleosis-like illness in adults. Most of the rashes are maculopapular but a fewA enterovirusesA may produce a petechial or vesicular rash. The secondA stage of syphilis usually presents 6 a€“ 8 weeks after the primary stage, but occasionally the chancre can still be present. Rocky Mountain spotted fever (RMSF) has already been discussed, but it is important to point out that theA rash of RMSFA may be maculopapular early in the course of the illness.
A discussion of all of these entities is beyond the scope of this chapter, but I would like to mention a few select syndromes.A DengueA has already been mentioned in the discussion of petechial rash but Dengue can present with a more generalized erythematous macular rash. Persons usually acquire the organism through contact of non-intact skin with salt water or through ingestion of raw seafood. The classic skin lesion isA ecthyma gangrenosum , which is described as an erythematous, indurated lesion with bullous formation followed by ulceration. Blood cultures are often positive but synovial fluid and skin biopsies are usually sterile.Neisseria gonorrhoeaecan be recovered from a mucosal site in approximately 80 % of patients withA disseminated gonococcal infection (DGI). The primary papule may go unnoticed and the eschar is the skin manifestation that is seen at the time of presentation with fever andlocalized adenopathyA (Table 8).
Humaninfection with anthraxA has been associated with infection in cattle or other herbivores such as goats, horses, and sheep. Infection can occur via the inhalation route but the most common means of transmission is through the bite of a flea from an infected rodent. The most common groups include patients with hematological malignancies, patients status post solid organ or bone marrow transplantation, and patients with Acquired Immunodeficiency Syndrome (AIDS). These skin lesions are seen in association with a wide variety of non-infectious, inflammatory illnesses and are felt to be immune mediated. It is estimated that up to 25 % of patients with acuteA Hepatitis BA will develop a serum-sickness-like reaction that includes a rash that can be urticarial in nature. The clinical picture is indistinguishable from that ofA disseminated Neisseria gonorrhoeae. Transaminases may not be elevated at the time, but Hepatitis B sAg will be positive.A Hepatitis CA virus infection can also result in a rash and arthritis presentation which may or may not be associated with cryoglobulinemia.
Fever may be present but the major manifestations include migratory polyarthritis, carditis, subcutaneous nodules, chorea and the characteristic rash named erythema marginatum.
This chapter is not meant to be encyclopedic but has tried to highlight some of the common and important causes of fever and rash.
Roseola rash is not considered to be a serious disease, but various children react differently.
By the time you get to notice a child’s high fever, the seizure may have already passed; therefore if you suspect a seizure, have the child checked by physician the right away.
For example, children sharing the same cup by someone who is infected will surely facilitate transfer of the virus.
The virus can be spread through the tiny drops of fluid expelled by the infected person by sneezing, laughing, talking, or coughing. As much as possible, extra effort should be done to prevent, if not stop, the spread of the virus. This skin ailment can also take place as an outcome of other diseases  like Pellagra, dermatomyositis and Bloom Syndrome. Therefore, making a timely and specific diagnosis in an adult with fever and rash can be extremely important.

This chapter will concentrate on infectious etiologies although non-infectious etiologies will be discussed as part of the differential diagnosis of each presentation. Organisms can produce toxins that can directly affect skin structure or can elicit an inflammatory response in the skin. Occupational exposures, contact with animals or ill individuals, ingestion of specific foods, sexual practices, and insect bites all may be important components of the history. Therefore it is important that the skin findings are accurately characterized.A Table 2 summarizes the common skin manifestations. The rash usually appears after the fever and initially may be maculopapular, becoming more petechial as the illness progresses.
A history of active intravenous drug use or a new or changing murmur on physical exam may also raise the suspicion for this entity. The classic pentad of TTP includes fever, hemolytic anemia, thrombocytopenia, neurologic dysfunction and decreased renal function.
The erythroderma is more pronounced in the skin folds (Pastia's Lines) and there is circumoral pallor.
These bullae tend to occur at sites of minor trauma (Nikolsky's sign) and the denuded areas eventually desquamate. This disease is seen mostly in young children and occurs commonly in the late winter and spring. The typical drug reaction that is seen seven to ten days into therapy is most commonly maculopapular in character. The rash follows the febrile period in this illness and the rash may recur with various stimuli such as sun exposure.
The rash is maculopapular and involves the face, trunk, and sometimes the extremities (including palms and soles). Rash occurs in about 5 % of patients and may be variable in nature (maculopapular, petechial, scarlatiniform, urticarial, or vesicular).
The rash associated with HHV6 is maculopapular in character, appears after resolution of fever, and spares the face. It is a rapidly enlarging erythematous macule often with central clearing resulting in a bull's eye appearance. Clearly an appropriate travel history would be an important clue.A Typhoid feverA is associated with centrally-distributed, erythematous macules or papules. Infection occurs as a result of exposure to infectious respiratory secretions or material from a Varicella or Zoster skin lesion. Patients with chronic liver disease, especially cirrhosis, are at increased risk of developingA sepsisA with this organism.
Some of these infections are of particular interest because of their potential role in bioterrorism.
A variety of animal products can be contaminated with the organism and can facilitate transmission of the infection: hides, wool, hair, meat, bones, and bone meal. Illness characterized by fever, headache, and tender enlarged lymph nodes (buboes) develops within 2 a€“ 7 days of the bite. Therefore it is important to sample the synovial fluid for culture in a patient with another potential cause for joint swelling and pain such as underlying Rheumatoid Arthritis. The rash is erythematous but not painful or pruritic, and occurs predominately on the trunk and proximal extremities.
Diagnosis and management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted fever, Ehrlichiosis, and Anaplasmosis a€“ United States. Some develop a mild case of roseola, while others experience the whole symptoms typical of roseola. Note that antibiotics are found to be ineffective in the treatment of viral diseases such as roseola.
Children who inhale the drops or touch them and touch their noses and mouth would most likely bring the virus closer to their body and even facilitate the entrance of the virus inside the system. If the child is sick due to roseola, it is better to isolate the child so to avoid infecting other children. An accurate characterization of the skin lesions and a thorough history can help narrow the differential diagnosis for a specific patient. Infections with localized or regional skin manifestations will also be included in this chapter. The skin manifestations associated with a specific infectious agent may be variable, and different types of skin lesions may be seen at different times in the course of one illness.
A thorough medication history should be obtained including immunizations, over-the-counter preparations, past and present medications and any history of adverse effects related to any of these substances. In addition to accurate characterization of the skin lesions attention should be paid to the distribution and arrangement of the lesions.
Epstein-Barr virus infections occur more frequently in children and young adults and present as a mononucleosis type syndrome characterized by pharyngitis, fever, malaise, adenopathy, splenomegaly and hepatitis. Demonstration of vasculitis on skin biopsy is an important component in the diagnosis of the systemic vasculitis syndromes.
The classic oral manifestation is the strawberry tongue, which can appear white or beefy red with prominent papillae.
For example, patients with chronic edema of the upper extremity following axillary lymph node dissection, or patients with chronic edema following saphenous vein graft harvest are at increased risk for developing cellulitis in the involved limbs. Patients complain of pain at the site that may seem out of proportion to the findings on physical examination. This syndrome is a manifestation of infection with strainsStaphylococcus aureusthat produce an exfoliative exotoxin. Patients present with fever,A conjunctivitis, erythema of the oral mucosa and lips, rash, andA cervical lymphadenopathy. The fever can precede the development of the rash, and both fever and rash resolve after removal of the causative drug. Recognition of Rubella may be especially important if a susceptible pregnant woman is exposed to a patient with fever and a maculopapular rash of unknown etiology.A Congenital RubellaA is associated with a large number of birth defects. The papular-purpuric gloves and socks syndrome (PPGSS) is an unusual manifestation of Parvovirus B 19 infection.
The skin rash associated with CMV can be variable in appearance but is usually maculopapular. Ehrlichiosis refers to disease secondary to infection withA rickettsia-like organismsA that are transmitted by ticks. The lesions are usually greater than 5 centimeters in diameter and occur on parts of the body where an attached tick may go unnoticed for 36 a€“ 48 hours.
The organism,A Salmonella typhi, can be cultured from skin lesions in about 50 % of cases but blood cultures are usually positive.
Conjunctival suffusion is common but the pretibial maculopapular rash is rare.A Lab studiesreveal thrombocytopenia, and an elevated BUN and bilirubin.
An individual is infectious prior to development of the rash therefore patients may be unaware of the exposure.
In neutropenic patientsA empiric antibiotic therapyusually includes an anti-pseudomonal penicillin or cephalosporin and an aminoglycoside. Vesiculation may occur at the site of cellulitis but systemic symptoms such as fever are rare with localized disease. Anthrax spores can survive for prolonged periods of time in the environment depending on environmental conditions. A more disseminated rash develops and goes through a similar series of stages: papulea†’vesiclea†’eschar. Sweet's syndrome, or febrile neutrophilic dermatosis, presents with fever and nodular skin lesions that ulcerate. A variety of collagen vascular diseases can have fever, rash, and arthritis as part of the clinical presentation.A variety of other infections can lead to the development of reactive arthritis (separate from Reiter's syndrome) and these causes are listed in (Table 12).
One infectious agent can cause many dermatological syndromes and many agents can present with an identical dermatological picture. The distribution may vary from patient to patient because in others, the rashes may reach the legs and the face while in some other patients, these areas are being spared.
Also note that children with roseola may have a low immunity; isolating them from others may also be helpful to facilitate faster healing and limiting their exposure to other opportunistic organisms that may add to the infection. So you have to make sure that proper treatment is done in this case.The Butterfly Rash can take place in form of periodic attacks. More than one mechanism may be involved in the development of a rash with a specific pathogen. Hospitalized patients should be placed on droplet precautions until they have received 24 hours of effective antimicrobial therapy. A third generation cephalosporin, such asA ceftriaxone, can be used to treat all of the above. Leukocytoclastic vasculitis can be seen with a variety of infections such as subacute bacterial endocarditis,A HIV infection, and chronic active hepatitis. Treatment includes supportive care and antimicrobial therapy effective forA Staphylococcus aureus. The rash can be variable in appearance: scarlatiniform, pustular, plaque-like, or maculopapular.
The majority of infections associated with fever and a maculopapular rash are viral and are not treatable (Table 6). Patients with PPGSS develop painful and pruritic swelling and erythema of the distal extremities.
A history of unprotected sexual intercourse or sharing needles used for injection of recreational drugs would be an important clue. Typhoid fever may be in the differential of fever and rash in the returned traveler.A TyphusA can present with fever and maculopapular rash. The illness can be biphasic with the second phase complicated by renal and hepatic failure.
Pseudomonas has also been associated with generalized vesiculopustular lesions associated withA hot tub exposure. When there is extensive mucosal involvement with conjunctivitis and stomatitis the term Stevens - Johnson syndrome is applied. Microscopic examination of skin lesions demonstrates polymorphonuclear cells and gram negative bacilli.
The etiology is unclear but it occurs predominately in individuals with hematological malignancies or other underlying disease. The diagnosis of ARF is based on the clinical manifestations andA evidenceA of recent GAS infection. The key is to narrow the differential diagnosis by accurate characterization of the rash and a thorough history and physical examination. You may have these allergic diseases when you are suffering from ailments like rosacea, windburn, scarlet fever, dermatomyositis, and pellagra. Skin lesions involving the skin are referred to as exanthems and skin lesions involving mucous membranes are referred to as enanthems.
Mucous membranes in both the oral and genital regions, in addition to the hair, scalp, nails and intertriginous areas should all be examined. Travel history is also vital as RMSF is acquired most commonly in the southern Atlantic and the south central states. The viruses of theA viral hemorrhagic feverA group can also cause fever and a petechial rash. Drug induced vasculitis with fever can be seen with a variety of different medications including allopurinol, phenytoin,A penicillin,A sulfonamides, and thiazides. There are indistinct borders to the involved skin.A ErysipelasA is a superficial cellulitis with prominent lymphatic involvement, resulting in induration with distinct borders and a peau d'orange appearance to the skin. Blood cultures may be positive, but skin biopsy is important to rule out Toxic Epidermal Necrolysis (TEN).
There is edema and erythema of the extremities including palms and soles, with subsequent desquamation starting in the periungual region. With aggressive vaccine programs some of these infections have become uncommon.A Measles (rubeola)A presents with fever, coryza and a maculopapular rash, which starts in the head and neck region and spreads centrifugally.
Recognition of the ARS is especially important as the highA viral loadsA seen in acute infection can result in increased risk of transmission. Virus specific antibody testing may be useful in the small number of cases where the monospot test is negative.
Moist gray papules called condylomata lata are visible in the mouth or on the labia, anus or scrotum.

The history should suggest the potential forA tick exposureA in the northeast, upper Midwest or far west regions of the United States. Patients present with fever and malaise followed by rash, which is characterized as vesicles on an erythematous base. Patients can have bullae at the site of the cellulitis or scattered bullae with dissemination of the infection. Drugs are the most common etiology for erythema multiforme, but it is associated with a variety of infectious agents including mycoplasma, HSV and other viruses.
An eschar develops at the site of skin inoculation within 3 a€“ 10 days, and there are associated tender regional lymph nodes, fever, headache, and malaise. The skin lesion develops 1 a€“ 12 days after exposure and initially is characterized as a pruritic papule. There are a number ofRickettsia spsthat are transmitted by ticks and present with a picture of fever, headache, inoculation eschar and regional lymphadenopathy. Once the differential is narrowed priority should be given to empiric therapy for patients who are unstable and may have a treatable, life-threatening infection. As treatment for some of these vasculitic syndromes may require corticosteroids or other immunosuppressive medications it is important to rule out active infection first.
Patients present with a syndrome of fever, diffuse erythematous rash, hypotension and multisystem dysfunction. Bullae may complicate skin infections with bothStaphylococcus aureusand beta hemolytic streptococci.
Drugs are the most common etiology for TEN, which results in full thickness skin necrosis and a 10 a€“ 30 % associated mortality. HME cases have been reported predominantly from southeastern and south central United States, and HGA cases have been concentrated in the northeast, upper Midwest and parts of the west coast.
Most cases occur between May and July, but transmission can be seen from early spring until late fall.
This disease has been associated with epidemics throughout the world and is endemic in many locations worldwide. The skin lesions are papular to vesicular and have a rim of surrounding erythema similar to the lesions of HSV or VZV. Each species has a specific geographic distribution and cases identified in the United States are seen in returning travelers. Isolation of certain patients with fever, or treatment of their contacts, may be important for public health reasons. Patients who appear acutely ill or have unstable vitals signs may require urgent hospitalization andA empiricA therapy (Table 3). Therefore patients suspected of having one of these viruses should be placed in isolation and the CDC and the state health department should be contacted immediately. The mucous membranes are often hyperemic and there is desquamation of the rash especially on the palms and soles. Surgical consultation should be obtained in patients where there is a suspicion forA necrotizing soft tissue infection.
Kawasaki syndrome can be complicated by cardiac involvement which is the major source of morbidity and mortality. Early in the course of the illness small white spots, Koplik's spots, are visible on the buccal mucosa opposite the lower molars.
Demonstration of viremia by polymerase chain reaction (PCR) in a patient with a consistent clinical syndrome supports the diagnosis of ARS. The clinical features of the illnesses are very similar: fever, headache, malaise, myalgias.
The classic skin manifestation, Horder's Spots, are pink maculopapular lesions that occur on the trunk. There is often surrounding non-pitting edema, associated tender lymphadenopathy, and satellite lesions.
The aminoglycosides streptomycin and gentamicin are theA drugs of choicebut doxycycline and ciprofloxacin may also be effective.
Aggressive diagnostic modalities should be pursued especially in immunocompromised patients.
Other areas to emphasize on the physical examination are lymph nodes, liver and spleen, joints, and cardiac auscultation. Blood cultures and skin cultures are usually negative, but the causative organism can be cultured from a colonized site.
Blood cultures are positive in a small percentage of cases and yield on culture of skin aspirate is low so the diagnosis is usually clinical. Appropriate managementincludes aggressive supportive care, surgical debridement, and broad spectrum antibiotic therapy to cover GAS, anaerobes, and gram negative bacilli.
Sezary syndrome, or cutaneous T cell lymphoma, can present with fever and diffuse erythroderma. The appearance is described as grains of sand embedded in the buccal mucosa.A Atypical measlesA can be seen in individuals that received the killed vaccine between 1963 and 1967. Patients with secondary syphilis may have hepatosplenomegaly with mild elevation of transaminases onA laboratory exam.
Rash occurs in approximately 30 % of adults and 60 % of children with HME, but rash is rare in HGA. A plaque is a flat-topped raised lesion greater than 1.5 centimeters in diameter and the lesions of psoriasis can be described as plaques. In addition to aggressive supportive therapy patients are treated with an antistaphylococcal antibiotic such asA nafcillin. These studies should not be performed routinely and should be reserved for severe cases, immunocompromised patients, or situations where there is increased suspicion for a resistant organism. Antimicrobial therapy can be tailored once results of blood and tissue cultures are available. The rash of atypical measles can be vesicular or purpuric and starts on the extremities and spreads centrally. In patients with underlying red blood cell disorders this infection can precipitate an aplastic crisis. The exanthem reported with ehrlichiosis is characterized as macular or maculopapular, and rarely involves the palms and soles. The latter are more likely to develop in adults.A Reye's syndromeA may be a complication in both children and adults. The skin lesions are usually not painful andA microscopic examinationA of the skin lesion fails to reveal inflammatory cells. In the past there was an association ofA STSSA with the use of super absorbent tampons in women, but the majority of the recent cases of Staphylococcal Toxic Shock Syndrome have been attributed to non-menstrual sources.
In individuals immunized with the live virus vaccine protection wanes with time and mild measles can occur in this population. Chronic anemia can develop following Parvovirus B19 infection in immunocompromised patients such as patients with Human Immunodeficiency Virus (HIV).
The Rapid Plasma Reagin (RPR) test should be positive at high titer with a positive Fluorescent Treponemal Antibody absorption test (FTA-Abs). Gastrointestinal or respiratory symptoms may be present.A Laboratory studiesA are significant for leukopenia, thrombocytopenia, and elevated transaminases. Treatment of early Lyme disease is usually effective and prevents the development of late complications ofBorreliainfection.
The disease can be seen worldwide but in the United States most cases have been seen in southern Texas and California. In the Western hemisphere, Rate Bite Fever is caused byA Streptobacillus moniliformis, whichcan be acquired from a rate bite or by ingestion of contaminated food. If hospitalized, patients with suspected or proven Varicella should be placed in strict isolation.
The organism can be cultured from specimens of exudates, skin, or blood obtained prior to initiation of antibiotics. Tissue should be sent for smear and culture for AFB and fungus.A NocardiaA can also cause nodular skin lesions in immunocompromised patients. Recognition of measles can be important as sporadic cases do occur and it is associated with significant morbidity in immunocompromised patients and in those at the extremes of age.
Symptomatic or asymptomatic acute infection with Parvovirus B19 during pregnancy has been associated with fetal death. Intramuscular injection of benzathine penicillin is still theA treatment of choiceA for primary and secondary syphilis.
Rapid diagnosis of HGA can be made if morulae are identified on peripheral blood smear but the percentage of infected leukocytes is variable.
Patients present with fever, headache, myalgias, and a maculopapular rash that involves the trunk and extremities including the palms and soles. Virus can be cultured from skin lesions but the results may take days and culture may not be available outside of tertiary care institutions.
Vesicles are well circumscribed, fluid-filled lesions up to 1 centimeter in diameter and vesicles that are greater than 1 centimeter in diameter are classified as bullae. Immunofluorescent staining of skin biopsy or four fold rise in IgG titers in serial serum specimens can be diagnostic but is not useful in acute management. Group A beta-hemolytic streptococcus (GAS), orStreptococcus pyogenes, is the most common causative organism but other streptococci can produce a similar clinical picture. Untreated secondary syphilis can result in late cardiac or neurological manifestations of disease.
The rash can be maculopapular, vesicular, pustular or petechia; and is concentrated on the hands, feet, palms and soles. A rapid diagnosis can be made by staining cells obtained from the base of a lesion with a monoclonal antibody to specificA VZVA proteins tagged with a fluorescent marker. No other rapid tests are routinely available; thereforeempiricdoxycyclineA should be started in patients with a history of tick exposure, travel to an area endemic for ehrlichiosis, and a consistent clinical syndrome. This Direct Fluorescent Antibody (DFA) testing may not be routinely available but can provide a specific diagnosis within hours. The skin lesions often have a vascular appearance and may be confused with the lesions ofA Kaposi Sarcoma.
A wheal or hive is a well-demarcated, elevated lesion that is usually pink in color and present for less than 24 hours.
TheA treatment of choice for PasteurellaisA amoxicillin-clavulanate, but a quinolone can also be used. Local recurrence ofA VZV, Zoster, can occur with dissemination especially in immunocompromised hosts. Gastrointestinal symptoms of nausea, vomiting, and diarrhea may occur early in the course of the illness. PCR and serology are available for diagnosis but results may not be available to aid in acute management. A third species,Ehrlichia ewingii, has been reported to cause a granulocytotropic picture of disease in immunocompromised hosts from Missouri, Tennessee, and Oklahoma.
Disseminated herpes simplex virus (HSV) infection also presents with fever and diffuse vesicular rash and occurs more frequently in immunocompromised patients or patients with severe eczema.
Bullae may develop at the local site of infection and the diffuse rash may desquamate during the convalescent phase of the illness.
Certain infections can present with a diffuse erythema which blanches with minimal pressure. Treatment includes aggressive supportive measures and empiric antibiotic therapy effective against staphylococcus, streptococcus, anaerobes and gram negative rods until a definitive diagnosis is made. Crusts , scales, ulcers, and excoriations are secondary lesions that can complicate any of the primary skin lesions mentioned above. In contrast to the rash seen with Varicella, in smallpox all of the skin lesions are at the same stage. The rash of smallpox is concentrated on the face and extremities including the palms and soles, where as the rash of Varicella is more concentrated on the trunk.
State and local health departments should be notified immediately in the case of suspected smallpox.

Type 1 oral herpes symptoms last
Herpes symptoms timeline 60
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